Successful endoscopic needle knife therapy combined with topical doxycycline injection of chronic sinus at ileal pouch-anal anastomosis.

Abstract

Chronic presacral sinus at the anastomosis after restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) has been difficult to manage and results in a high rate of pouch failure. The aim was to present a novel technique with a combining endoscopic doxycycline injection and needle knife therapy for a sinus at the ileoanal anastomosis. We applied repeat Doppler ultrasound-guided endoscopic needle knife therapy to open the orifice of the anastomotic sinus followed by topical injection of doxycycline. After six sessions of the endoscopic therapy, the refractory sinus was completely healed.   The Doppler ultrasound guided endoscopy therapy may provide an alternative treatment option for the patients with anastomotic sinus.